Current management of intraventricular hemorrhage

Engelhard, Herbert H.; Andrews, Carlota O; Slavin, Konstantin V.; Charbel, Fady T.

doi:10.1016/s0090-3019(03)00144-7

Cited by 81 publications

(50 citation statements)

References 37 publications

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“…5 In cases of persisting malresorptive hydrocephalus and the need for repeated EVD changes, placement of VP-shunt is usually indicated. The pathophysiology of a communicating malresorptive hydrocephalus after IVH is still not fully understood, but dysfunction of the CSF reabsorbing Pacchioni granulations of the arachnoidea caused by mass effect of the ventricular blood clots and thus deequilibration of the physiological workflows of the arachnoidea seem to be major factors.…”

Section: Discussionmentioning

confidence: 99%

“…4 In these cases, a permanent ventriculoperitoneal--shunt (VP-shunt) is usually indicated. 5 However, in patients with a communicating hydrocephalus, sufficient extracorporal cerebrospinal fluid (CSF) drainage could be achieved by insertion of a lumbar drainage (LD), thereby replacing the EVD and extending the time for recovery of the Pacchioni granulations. Our objective was to evaluate the feasibility and potential benefits of LD in ICH patients with communicating hydrocephalus.…”

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Intracerebral Hemorrhage With Severe Ventricular Involvement

Huttner¹,

Nagel²,

Tognoni³

et al. 2007

Stroke

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Background and Purpose-The objective was to analyze the feasibility of a lumbar drainage (LD) for a communicating malresorptive hydrocephalus in patients with supratentorial hemorrhage (intracerebral hemorrhage) accompanied by severe ventricular involvement (intraventricular hemorrhage) who required an external ventricular drain (EVD). Methods-In this retrospective study, 16 patients received an EVD and concurrent LD and were compared with 39 historical patients treated with EVD alone. The duration of required EVD and need for permanent ventriculoperitonealshunt were analyzed. Results-LD was inserted after 12 (4 to 18) days. In LD-treated patients, the LD was capable to replace repeated EVD exchanges, resulting in a shorter EVD-duration (12 versus 16 days) compared with patients treated with EVD alone. The overall duration of extracorporal cerebrospinal fluid drainage was longer (16 days EVD versus 21 days EVDϩLD) and the frequency of ventriculoperitoneal-shunt lower (18.75% versus 33%; PϽ0.03) in LD-treated patients. Conclusion-Our data suggest that LD is safe and feasible for treatment of nonpersistent communicating hydrocephalus after intracerebral hemorrhage. After adequate treatment of the occlusive hydrocephalus using an EVD in the acute phase, LD discloses an alternative for further extracorporal cerebrospinal fluid drainage. (Stroke. 2007;38:183-187.)

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Intracerebral Hemorrhage With Severe Ventricular Involvement

Huttner¹,

Nagel²,

Tognoni³

et al. 2007

Stroke

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“…Most IVH is secondary and related to hypertensive hemorrhages involving the basal ganglia and thalamus. 202,205 Although the insertion of a VC should theoretically aid in drainage of blood and CSF from the ventricles, VC use alone may be ineffective because of difficulty maintaining catheter patency and the …”

Section: Intraventricular Hemorrhagementioning

confidence: 99%

Guidelines for the Management of Spontaneous Intracerebral Hemorrhage

Hemphill¹,

Greenberg²,

Anderson³

et al. 2015

Stroke

2,951

1,196

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2032Purpose-The aim of this guideline is to present current and comprehensive recommendations for the diagnosis and treatment of spontaneous intracerebral hemorrhage. Methods-A formal literature search of PubMed was performed through the end of August 2013. The writing committee met by teleconference to discuss narrative text and recommendations. Recommendations follow the American Heart Association/American Stroke Association methods of classifying the level of certainty of the treatment effect and the class of evidence. Prerelease review of the draft guideline was performed by 6 expert peer reviewers and by the members of the Stroke Council Scientific Oversight Committee and Stroke Council Leadership Committee. Results-Evidence-based guidelines are presented for the care of patients with acute intracerebral hemorrhage. Topics focused on diagnosis, management of coagulopathy and blood pressure, prevention and control of secondary brain injury and intracranial pressure, the role of surgery, outcome prediction, rehabilitation, secondary prevention, and future considerations. Results of new phase 3 trials were incorporated. Conclusions-Intracerebral hemorrhage remains a serious condition for which early aggressive care is warranted.These guidelines provide a framework for goal-directed treatment of the patient with intracerebral hemorrhage.

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“…Si bien clásicamente su manejo se basaba en la colocación de un drenaje ventricular externo, se ha reportado con frecuencia creciente el uso de fibrinolíticos administrados a través del mismo catéter. Este tratamiento parece reducir el tiempo de permanencia de la sangre en los ventrículos y disminuir la mortalidad de los pacientes en torno a un 30%, aún cuando no está todavía claro si mejora la evolución neurológica en los supervivientes 7 . -En cuanto a la técnica quirúrgica a emplear para la evacuación del hematoma no hay datos que permitan seleccionar la craneotomía o procedimientos menos invasivos.…”

Section: Discussionunclassified

Tratamiento quirúrgico de la hemorragia intracerebral espontánea: Parte I: Hemorragia supratentorial

Pérez-Núñez¹,

Lagares

Pascual

et al. 2008

Neurocirugía

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ResumenLa hemorragia intracerebral espontánea (HIE) constituye uno de los procesos ictales de mayor gravedad. A pesar de esto y de una elevada incidencia, su tratamiento médico no va mucho más allá de un papel de soporte vital y control médico de la hipertensión intracraneal, y las indicaciones del tratamiento quirúr-gico están pobremente basadas en evidencia científica.El objetivo del presente trabajo fue revisar las bases de la indicación quirúrgica en la HIE supratentorial.Encontramos 10 ensayos clínicos y 5 meta-análisis en lengua inglesa que analizaban la utilidad del tratamiento quirúrgico en esta patología. Aunque globalmente estos estudios no mostraron un beneficio significativo del tratamiento quirúrgico en el conjunto de pacientes con HIE supratentorial, existe un subgrupo de pacientes en los que parece que dicho tratamiento podría ser beneficioso.En la hemorragia intracerebral espontánea supratentorial las recomendaciones actuales indican que los pacientes jóvenes, con hematomas lobares cuyo volumen causa un deterioro del nivel de consciencia, deben ser intervenidos. En pacientes con hematomas putaminales que reúnen las mismas condiciones de edad y deterioro neurológico la cirugía podría mejorar la evolución, al menos en términos de supervivencia. Un grave deterioro neurológico con GCS<5, la localización talámica y la presencia de una situación basal o edad que impidan una adecuada recuperación funcional, son criterios considerados tradicionalmente contraindicación del tratamiento quirúrgico. Dada la ausencia de evidencia científica sólida en la que sustentar estas recomendaciones, la decisión terapéutica debe realizarse de manera individualizada y prestando atención al soporte sociofamiliar del paciente, que jugará un papel importante en la evolución del mismo a medio/largo plazo.PALABRAS CLAVE: Hemorragia intracerebral. Cirugía. Tratamiento. Surgical treatment for spontaneous intracerebral haemorrhage. Part I: Supratentorial haematomas SummarySpontaneous intracerebral haematoma (SICH) represents one the most severe subtypes of ictus. However, and despite a high incidence, medical treatment is almost limited to life support and to control intracranial hypertension and indications of surgical treatment are poorly defined.The aim of this paper was to review the evidence supporting surgical evacuation of SICH.Ten clinical trials and five meta-analyses studying the results of surgical treatment on this pathology were found on English literature. These studies considered all together, failed to show a significant benefit of surgical evacuation in patients with SICH considered as a whole. However, a subgroup of these patients has been considered to potentially present a better outcome after surgical treatment.Current recommendations on supratentorial intracerebral haemorrhage state that young patients with lobar haematomas causing deterioration on the level of consciousness should be operated on. Patients suffering from putaminal haematomas and fitting with the same criteria of age and neurological deterio...

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Current management of intraventricular hemorrhage

Cited by 81 publications

References 37 publications

Intracerebral Hemorrhage With Severe Ventricular Involvement

Intracerebral Hemorrhage With Severe Ventricular Involvement

Guidelines for the Management of Spontaneous Intracerebral Hemorrhage

Tratamiento quirúrgico de la hemorragia intracerebral espontánea: Parte I: Hemorragia supratentorial

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